Dietary formulation and feeding management during the dry period, peripartal period, and early postpartum (fresh) period may facilitate or interrupt many of these steps before pregnancy is established and maintained. There is little evidence that milk yield per se contributes to greater disease occurrence. However, peak disease incidence (shortly after parturition) corresponds with the time of greatest negative energy balance (NEB), the peak in blood concentrations of NEFA, and the greatest acceleration of milk yield. Decreased fertility in the face of increasing milk production may be attributable to greater severity of postpartal NEB resulting from inadequate transition management or increased rates of disease. The depth and duration of NEB is highly related to DMI. Periparturient diseases can be a result from adverse ruminal conditions caused by excessive grain in the precalving or fresh cow diet, perhaps aggravated by overcrowding, heat stress, or other stressors. Others also have implicated inflammatory responses in alterations of metabolism, occurrence of health problems and impaired reproduction. A major area of concern in the fresh cow period is sudden increase in dietary energy density leading to subacute ruminal acidosis (SARA), which can decrease DMI and digestibility of nutrients. Adequate physical form of the diet, derived either from ingredients or mixing strategy, must be present to stimulate ruminal activity and chewing behavior. Dietary starch content and fermentability likely interact with forage characteristics and ration physical form. The comparison of 3 dietary starch contents (primarily from corn starch) in the fresh cow period for cows fed a controlled energy-type ration in the dry period. In conclusion, formulation and delivery of appropriate diets that limit total energy intake to requirements but also provide proper intakes of all other nutrients (including the most limiting amino acids methionine and lysine) before calving can help lessen the extent of NEB after calving. Effects of such diets on indicators of metabolic health are generally positive, suggesting the potential to lessen effects of periparturient disease on fertility.